Provider Demographics
NPI:1205100864
Name:VLASICAK, JAMES ALOIS (MA, JD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALOIS
Last Name:VLASICAK
Suffix:
Gender:M
Credentials:MA, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 EGLESTON AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2223
Mailing Address - Country:US
Mailing Address - Phone:269-217-4056
Mailing Address - Fax:
Practice Address - Street 1:618 EGLESTON AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2223
Practice Address - Country:US
Practice Address - Phone:269-217-4056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional